Research Article ISSN 2639-9458 Microbiology & Infectious Diseases Borrelia Invasion of Brain Pyramidal Neurons and Biofilm Borrelia Plaques in Neuroborreliosis Dementia with Alzheimer’s Phenotype Alan B. MacDonald* *Correspondence: Alan MacDonald MD, Pathologist, Molecular Interrogation Pathologist, Consultant, Borrelia Research Laboratory, University Research Laboratory, 8944 St. Lucia Drive Suite 201, Naples, of New Haven, West Haven, Connecticut, 06576. Florida, 34114, USA. Received: 12 Janaury 2021; Accepted: 05 February 2021 Citation: MacDonald,Alan B. ,"Borrelia Invasion of Brain Pyramidal Neurons and Biofilm Borrelia Plaques in Neuroborreliosis Dementia with Alzheimer’s Phenotype". Microbiol Infect Dis. 2021; 5(1): 1-11. ABSTRACT Dementia in Lyme borreliosis complex has been reported, mainly in post-mortem studies without available antemortem evidence of active Borrelia infection. Blanc in 2014 studied living patients with Lyme neuroborreliosis dementia and several dementia phenotype illnesses including an Alzheimer’s Phenotype. Herein we report an additional case study of a longitudinal evolution of European neuroborreliosis over eight years from tick bite to mild cognitive disease, to advanced dementia to death with a brain Alzheimer’s disease phenotype and concurrent Borrelia deposits in brain Alzheimer’s disease sites at autopsy. Intrathecal Borrelia specific Antibodies were detected by Commercial diagnostic laboratories (antemortem). Molecular autopsy tissue imaging was completed with borrelia specific DNA probes and an Immunomicroscopic detection histopathology method. Results: Autopsy showed intact spirochetes, fragmented spirochetes, deposits of Borrelia-specific proteins inside plaque lesions and inside of neurons, and Borrelia DNA deposits in plaque and neuronal sites. Pure Alzheimer’s disease (without Lewy bodies) was a routine neuropathological finding. CSF evidence for a brain compartment immune response is established here. Intrathecal antibodies to infection presented as oligoclonal total CSF IgG bands (n=twelve increase to n=13 bands) and separate Borrelia IgG Western blot band analysis in Cerebrospinal fluids (seven diagnostic Borrelia CSF antibody bands). Blood Western blot disclosed triple borrelia species infection; burgdorferi European type (eighteen bands), garinii (twelve bands) and afzelii (eighteen bands). Total Borrelia IgG antibodies in blood during life were two hundred-fold higher than normal range. Western blot of Cerebrospinal fluid prior to death disclosed 7 protein bands which were not represented in simultaneous blood Western blot studies, further validating the Intrathecal fingerprint of a separate brain compartment immune response to neuroborreliosis infection. Conclusion: Borrelia protein antigenic stimulation of intrathecal Borrelia antibodies was caused by resident deposits of spirochetal protein deposits in plaques, in diseased neurons, and in neuropil brain sites, and in intact brain spirochetes. Deposits of Borrelia proteins inside neurons and Brain phagocytes and in Neuropil sites (invasosomes) confirm remnants of chronic brain infection. Microbiol Infect Dis, 2021 Volume 5 | Issue 1 | 1 of 11 Keywords his mid-fifties followed by persistent arthralgias, joint stiffness, Neuroborreliosis, Dementia, Alzheimer’s, Intrathecal. autonomic dysfunction with hyperhidrosis, ‘transient global amnesia’ and pronounced fatigue from age 56-60. He retired from Abbreviations medical practice. Dementia began at age 61 with cognitive and DAB- Diamino Benzidine (brown chromogen); FISH- Fluorescence memory deficiencies, confirmed by neuropsychiatric testing. From in Situ Hybridization technique; IHC – Immunohistochemistry 2003-2006 he developed dysarthria, agraphia, muscle spasms of the technique; HS – Hippocampal Sclerosis; LD – Lewy; Body legs, photophobia and hyperacusis. Parenteral combination antibiotic Dementia illnesses (of Blanc 2014); NBD - Lyme Neuroborreliosis therapy-pulsed with oral antibiotics was administered without durable Dementia (of Blanc 2014); VD- Vascular Dementia (of Blanc curative effect from 2007-2009. He developed psychosis and died in 2014); WB – Western Blot serology technique. 2010 in the seventh year of his dementing illness. Introduction Methods Dementia due to European Neuroborreliosis with simultaneous Autopsy, routine neuropathology and Borrelia forensic methods: neurodegeneration/brain atrophy was established by Blanc and Brain Autopsy was performed by a board-certified neuro colleagues and published in the Journal of Alzheimer’s Disease pathologist. A second forensic type molecular analysis for DNA in 2014 [1]. Thirteen dementia patients with notable intrathecal of Borrelia focused on brain tissue re-examination and utilized recut antibody formation to Borrelia infection demonstrated radiological tissue unstained slides from three brain sites; right and left hippocampal evidence of brain atrophy and clinical recalcitrance to cure after tissue (site CA1) and cerebral cortex (Right frontal lobe). three weeks of parenteral antibiotics. Only one patient died during Blanc’s study and that patient autopsy disclosed Alzheimer’s Immunohistochemistry Method disease. No attempt was made to identify Borrelia microbes Decoration (labeling) of Borrelia antigens in brain tissue sites IHC in that patient’s brain. Herein we describe an additional case of immunoperoxidase method Stage 1: Binding of Rabbit polyclonal intrathecal antibody positive borrelia dementia in which autopsy antibodies to sites followed by Stage 2 incubation with anti-rabbit confirmed simultaneous Alzheimer’s disease. Intact Borrelia antibody linked to horseradish peroxidase; Stage 3; Chromogen spirochetes and their fragments, and Borrelia-specific protein and deposition at sites of Bound Anti-Borrelia rabbit antibody (Di DNA deposits in plaques in diseased neocortical brain sites were Amino Benzidine DAB-) resulting in a brown chromogen product microscopically confirmed. The spatial distribution of Borrelia deposition on specific tissue sites. Ventana iView DAB kit [IHC infection overlapped with the distribution of Alzheimer’s Disease- Kit for detection of Rabbit antibodies] (product #: Roche Tissue specific lesions. Borrelia communities in plaque form, Borrelia Diagnostics; Catalogue 760-091 – according to Manufacturer’s inside of diseased neurons, and Borrelia vascular invasion were instructions with final Chromogen development (DAB); ABCAM documented by Fluorescence in situ Hybridization-(FISH)) and by Inc. www.abcam.com (Catalogue ab20950) Borrelia polyclonal antigen/antibody binding (immunohistochemistry) with Borrelia- antibodies: Harvested from rabbit immunized with total Borrelia specific antibodies. This is the first report of tissue confirmation proteins in a pure culture digestion product. by molecular diagnostic, methods of persistent brain Borrelia tissue infection in a patient with dementia during life. Our DNA probe/ FISH method research methodology is easily adaptable to future autopsy studies Fluorescence in situ DNA Hybridization (FISH) was performed as of dementia patients and is within the reach of every hospital previously described by Sapi et al. (doi 10:1556/1886.2015.00049, pathologist. European Journal of Clinical Microbiology and Infectious Disease; 2016) All control bacterial species validated for specificity of Intrathecal immune response to borrelia in Blanc’s study of Borrelia hybridizations – with a Borrelia burgdorferi probe to NBD-Neurodegenerative subtype provides for legitimacy of two Flagellin B 22 nucleotide sequence: Flagellin B open Reading pathways (infection and degeneration) to a dementia phenotype. frame (BBO 0147) were bacterially validated. Probe Sequence: (LNBD). Like the model of simultaneous Lewy Body disease/ (nucleotide) TGG GAG TTT CTG GTA AGA TTAA; --- fluorescein Alzheimer’s disease, a sound and validated system for two isethionate label 5’ position. separate dementia ontogenies and provenance are combined in one brain [1.,2,3]. Blanc described mixtures of NBD with Antemortem blood and CSF serology coexistent AD, LD, HS, VD, FTD phenotypes. We encourage Data from commercial and reference laboratories in the future research to dissect these mixed categories. Separate, equal Netherlands and in Switzerland were entered a spreadsheet, and and co-incident may or may not be united by evidence in linkages results were tabulated and graphically displayed for visual analysis of infection and neurodegeneration, as was previously proven in of Cerebrospinal Intrathecal and peripheral blood antibodies to General Paresis by Noguchi and Moore in 1913. borrelia infectomes. Case presentation Digital Image Capture hardware and software This patient died with severe dementia at age 68. His past medical Digital images were captured with an Omax light microscope history was positive for erythema migrans in perineal skin in outfitted for Fluorescence Imaging and An Omax five-megapixel Microbiol Infect Dis, 2021 Volume 5 | Issue 1 | 2 of 11 camera (with a 0.5 reducing lens) through a trinocular head. Discussion Images were recorded in TIFF format at the highest permitted Etiologic toxic protein co-travelers (pTau, Beta 1-24 Amyloid, optical resolution allowed by the manufacturer supplied image ASN) in the dementia brain are invisible in Hematoxylin and Eosin capture software. (H&E) stained autopsy microscopy specimens but are disclosed in advanced Immunohistochemistry (IHC) labelling procedures. Results Etiologic Borrelia infection toxic protein products are invisible